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Peripheral neuro examination and common findings - Coggle Diagram
Peripheral neuro examination and common findings
WIPER
General inspection
Around the room
Equipment - wheelchairs, supplemental oxygen, NIV
Medications
At the patient
Deformities
Wasting
Asymmetry
Rashes
Fasciculations
Scars and skin
Neurocutaneous findings
Champagne bottle
Lipodermatosclerosis
Charcot Marie Tooth
GAIT! Ask to go for a walk
LOOK at the arm swing, which will be reduced on affected side in hemiparesis
Unable to heel walk - more suggestive myopathy, or L3/L4
Unable to toe walk - more suggestive neuropathy
Maybe ask to run, if they can?
Heel-toe - to assess for ataxia
Sensory
Muscular
Cerebellar
Dysdiadochokinesia
Ataxia
Intention tremor
Hypotonia
Slurred/staccato speech
Nystagmus
Then look ALL around the patient, including the back/spine, face, arms and legs, looking for:
Tone and clonus
Power
Reflexes
Biceps - C5/C6
Triceps - C7/C8
Brachioradialis - C5/C6
Knee jerk - L3/L4
Ankle jerk - S1/S2
Plantar
Sensation
vibration and proprioception - dorsal columns
Pin prick and temp - spinothalamic
Fine touch - both tracts
To complete
Measure head circumference
Plot height and weight on an appropriate growth chart
Cranial nerve and eye exam
Examine for cerebellar signs (if appropriate)
Acquired
Stroke
Trauma
Tumour
MS
Congenital
Friedrich's ataxia
Cerebellum
Pyramidal tracts
Peripheral nerves
Pes cavus
Kyphoscoliosis
Also need to listen to the heart, because of associated hypertrophic cardiomyopathy
Arnold-Chiari
Drugs
Phenytoin
Lead poisoning
Examine other systems
eg heart - Friedrich's - HOCM
Romberg's
Positive if an ataxia is SENSORY in nature
Negative if an ataxia is cerebellar in nature
Coordination
Finger-nose
Heel up shin
Upper motor neurone predominance
Lower motor neurone predominance
Mixed